Larutan pencuci hidung salin isotonis tidak terbukti mempercepat waktu transpor mukosilia pada pasien dengan rinosinusitis akut di RSUP Sanglah, Bali, Indonesia

Background: Mucociliary clearance is a significant element of the defence system of the entire respiratory tract. Impairment of the mucociliary clearance serves as a medium for sinonasal infections. Saline nasal irrigation is believed to alleviated rhinosinusitis symptoms by clearing excess mucus, reducing congestion and remove infectious materials from the inspired air. This study aimed to determine the efficacy of mucociliary transport time of isotonic saline nasal solutions in patients with acute rhinosinusitis.

Methods: An experimental study using pre- and post-test with control group design was conducted in this study. Mucociliary transport time was measured by the saccharine test on 20 acute rhinosinusitis patients before and after 7 days’ treatment with intranasal isotonic saline solutions and standard therapy (ciprofloxacin, pseudoephedrine/ triprolidine, ambroxol) for the case group and standard treatment for the control group. Data were analysed using SPSS version 20 for Windows.

Result: The average mucociliary transport time before therapy was 35.5±10.7 minutes and 29.2±7.7 minutes for the case group and control group, respectively. The average mucociliary transport time after therapy was 22.9±8.7 minutes and 18.0 ± 5.6 minutes for case group and control group, respectively. The mean difference mucociliary transport time before and after therapy was 11.0±7.5 minutes and 9.4±5.3 minutes for the case and control group, respectively (p=0.499).

Conclusions: The addition of intranasal isotonic saline solutions in acute rhinosinusitis patients has the same effect of mucociliary transport time with oral medication with the antibiotic, decongestant, and mucolytic without intranasal isotonic saline solutions.

Latar Belakang: Transpor mukosilia merupakan salah satu mekanisme pertahanan saluran pernapasan. Adanya gangguan pada sistem tersebut menjadi predisposisi terjadinya infeksi sinonasal. Larutan pencuci hidung dengan salin isotonis dipercaya dapat mengurangi gejala akibat rinosinusitis dengan cara membersihkan sekret, mengurangi odema dan mengeluarkan bahan-bahan berbahaya yang masuk bersama udara pernapasan. Tujuan penelitian ini adalah untuk menilai efektivitas waktu transpor mukosilia larutan pencuci hidung salin isotonis pada pasien rinosinusitis akut.

Metode: Uji eksperimental dengan desai pre-post test dengan kontrol dilakukan pada penelitian ini. Waktu transpor mukosilia diukur menggunakan uji sakarin terhadap 20 pasien rinosinusitis akut sebelum dan 7 hari sesudah pemberian larutan pencuci hidung salin isotonis dan terapi standar (ciprofloxacine, pseudoephedrine/triprolidine, ambroxol) pada Kelompok Perlakuan dan terapi standar pada Kelompok Kontrol. Data dianalisis menggunakan SPSS versi 20 untuk Windows.

Hasil: Rerata waktu transpor mukosilia sebelum perlakuan pada Kelompok Perlakuan adalah 35,5 ± 10,7 menit dan 29,2 ± 7,7 menit pada Kelompok Kontrol. Rerata waktu transpor mukosilia sesudah terapi adalah 22,9 ± 8,7 menit dan 18,0±5,6 menit berturut-turut pada Kelompok Perlakuan dan Kelompok Kontrol. Median selisih waktu transpor mukosilia sebelum dan sesudah terapi adalah 11,0±7,5 menit pada Kelompok Perlakuan dan 9,4 ± 5,3 menit pada Kelompok Kontrol (p=0,499).

Kesimpulan: Penambahan larutan cuci hidung salin isotonis pada rinosinusitis akut memiliki efek waktu transpor mukosilia yang sama dengan pemberian antibiotika, dekongestan dan mukolitik tanpa larutan cuci hidung salin isotonis.

Perubahan tingkat pengetahuan pasca penyuluhan penyakit menular tuberculosis (TB) terhadap masyarakat di Desa Tojan, Klungkung, Puskesmas Klungkung I, Bali, Indonesia

Background: Tuberculosis (TB) is one of the infectious diseases that still need attention, especially in developing countries where the prevalence is still high. Health promotion is a step that can be done to prepare citizens in terms of their abilities and knowledge regarding TB disease. This study aims to see changes in people's knowledge after health promotion about TB in the village of Trojan, Klungkung, Bali.

Methods: A cross-sectional descriptive study has been conducted to assesses the knowledge responses before and after delivery of material on TB. Health promotion was carried out on April 2^nd 2018 in Banjar Desa Trojan Klungkung. Before giving the material 3 questions were given to 3 participants randomly, then after giving the material for 30 minutes, 3 questions were given to 9 random communities. Data were analyzed using SPSS version 17 for Windows

Results: A total pre-test score was 44.4% while the post-test score was 88.9% where there was an increase of 44.5% after the material was given. In addition, all of the respondents showed a perfect post-test score (100,0%) both in the questions related to the symptoms of TB as well as the route of transmission for TB, respectively,

Conclusion: This study shows that there is an increase in knowledge after the provision of health promotion through post-test evaluation.

Latar Belakang: Tuberkulosis (TB) merupakan salah satu penyakit menular yang masih perlu diperhatikan terutama di negara berkembang dimana prevalensinya masih tinggi. Penyuluhan merupakan suatu langkah yang dapat dilakukan untuk mempersiapkan warga dalam hal kemampuan dan pengetahuan mengenai penyakit TB. Studi ini bertujuan untuk melihat perubahan pengetahuan warga setelah dilakukan penyuluhan mengenai TB di Desa Trojan, Klungkung, Bali.

Metode: Sebuah studi potong lintang deskriptif telah dilakukan untuk menilai respon pengetahuan sebelum dan sesudah penyampaian materi penyuluhan mengenai TB. Penyuluhan dilakukan pada tanggal 2 April 2018 di banjar Desa Trojan Kelungkung. Sebelum pemberian materi diberikan 3 buah pertanyaan kepada 3 peserta secara acak, kemudian setelah pemberian materi selama 30 menit, diberikan 3 buah pertanyaan kepada 9 masayarakat acak. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Total nilai pre-test adalah 44,4% sedangkan nilai post-test adalah 88,9% dimana terjadi peningkatan sebesar 44,5% setelah pemberian materi. Di samping itu, seluruh responden menunjukkan hasil nilai post-test sempurna (100,0%) baik pada pertanyaan yang berhubungan dengan gejala TB maupun jalur transmisi TB, secara berturut-turut.

Kesimpulan: Studi ini menunjukkan bahwa terdapat peningkatan pengetahuan setelah pemberian penyuluhan melalui evaluasi post-test.

Profil pioderma pada anak usia 0-14 tahun di Rumah Sakit Umum Pusat (RSUP) Sanglah, Denpasar periode Juni 2015-2016

Background: Pyoderma is a skin infection caused by bacteria Staphylococcus, Streptococcus, or both of it. Pyoderma often experienced by children which caused he skin resistance against the invasion of pathogenic germs, which not perfect as ts. Pyoderma morbidity in pediatric patients still occurs, especially in developing countries with tropical climates. This study aims to determine the pyoderma profile among children 0-14 years old at Sanglah General Hospital, Denpasar, in June 2015-2016 period.

Methods: A cross-sectional descriptive design using a retrospective approach was conducted in this study. Samples were determined using total sampling technique and this sample using pediatric patients aged 0-14 years in Sanglah General Hospital periods June 201 5to June 2016 who had pyoderma. The data obtained in this study were analyzed descriptively using SPSS version 17 for Windows.

Results: The results founded that there were 347 admissions, 53 patients suffering from pyoderma in Sanglah General Hospital. The majority of patients aged ≤ 4 years were 31 patients (58.5%), followed by the sex of the male as many as 34 patients (64.2%), diagnosis of bullous impetigo 27 patients (50.9%) and the location of lesions on the head of 32 patients (60.4%). Positive results of gram-positive coccus examination were 28 patients (52.8%) followed by the majority of patients getting a combination of topical and systemic antibiotics were 42 patients (79.2%).

Conclusion: According to the data analysis and discussion, it can be concluded that the incidence of pyoderma in children is still quite a lot happening in Sanglah General Hospital during June 2015-2016 period.

Latar Belakang: Pioderma merupakan infeksi kulit yang disebabkan oleh kuman staphylococcus, streptococcus, atau oleh keduanya. Pioderma sering dialami anak-anak, karena daya tahan kulit terhadap invasi kuman pathogen belum sesempurna orang dewasa. Angka morbiditas pioderma pada pasien anak masih cukup terjadi terutama di negara berkembang dengan iklim tropis. Tujuan dari penelitian ini adalah ntuk mengetahui profil pioderma pada anak usia 0-14 tahun di Rrumah Sakit Umum Pusat Sanglah Denpasar periode Juni 2015- Juni 2016.

Metode: Penelitian ini menggunakan studi potong lintang deskriptif dengan desain penelitian retrospektif. Sampel ditentukan dengan menggunakan teknik total sampling, dalam sampel ini yang digunakan adalah pasien anak yang berusia 0-14 tahun di Rumah Sakit Umum Pusat Sanglah Denpasar periode Juni 2015- Juni 2016 yang mengalami pioderma. Data yang diperoleh dalam penelitian ini dianalisis secara deskriptif menggunakan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian secara deskriptif menunjukan bahwa dari 347 kunjungan, 53 pasien yang menderita pioderma di Rumah Sakit Umum Pusat Sanglah Denpasar. Sebagian besar pasien berusia ≤ 4 tahun sebanyak 31 pasien (58.5%), diikuti dengan jenis kelaminl laki-laki sebanyak 34 pasien (64.2%), diagnosis impetigo bulosa 27 pasien (50.9%) dan lokasi lesi pada kepala yaitu 32 pasien (60.4%). Hasil positif pemeriksaan kokus gram positif sebanyak 28 pasien (52.8%) diikuti dengan sebagian besar pasien mendapatkan kombinasi topikal dan antibiotik sistemik adalah 42 pasien (79.2%).

Kesimpulan: Berdasarakan hasil analisis data dan pembahasan, maka dapat disimpulkan bahwa insidens pioderma pada anak masih cukup banyak terjadi di Rumah Sakit Umum Pusat Sanglah periode Juni 2015-2016.

Gambaran hasil pemeriksaan endoskopi pada pasien dispepsia di Rumah Sakit Umum Pusat (RSUP) Sanglah tahun 2015

Background: Dyspepsia is recurrent and persistent pain or discomfort in the upper abdomen. Dyspepsia can be divided into two, which are organic dyspepsia and functional dyspepsia, respectively. Endoscopy is one of the recommended diagnostic tools for dyspepsia. This study aims to describe the endoscopic results in dyspeptic patients at Sanglah General Hospital.

Method: The quantitative cross-sectional descriptive study design was used. This study used secondary data from medical records. The sample population of this study was patients with dyspepsia who undergone endoscopy procedure at the Sanglah Central General Hospital in 2015 with a total sampling method that resulted in 260 samples. Data were analyzed using SPSS version 21 for Windows.

Results: The sex of the respondents involved in this study were male (50.8%) and female (49.2%), which have almost the same percentage. Nearly half of the study respondents were 41-60 years old (47.7%). About 92.3%, patients were organic dyspepsia and 7.7%, functional dyspepsia. While the most diagnosed endoscopic examination results were gastritis (40.0%) and found in the young age group (≤ 64 years).

Conclusion: Patients with symptoms of dyspepsia are mostly male, young adults, have organic dyspepsia, and the picture of endoscopic examination is dominated by gastritis at a young age.

Latar Belakang: Dispepsia adalah nyeri yang berulang dan menetap atau rasa tidak nyaman di daerah perut bagian atas. Dispepsia dapat dibagi menjadi dua yaitu dispepsia organik dan dispepsia fungsional. Endoskopi merupakan salah satu alat diagnostik yang di rekomendasikan untuk diagnosis dispepsia. Penelitian ini bertujuan untuk mengambarkan hasil endoskopi pada pasien dispepsia di RSUP Sanglah.

Metode: Desain studi penelitian deskriptif kuantitatif cross sectional dengan menggunakan data sekunder dari rekam medis. Populasi sampel penelitian ini adalah pasien dispepsia yang melakukan endoskopi di Rumah Sakit Umum Pusat Sanglah Tahun 2015 dengan metode Total sampling yang menghasilkan 260 sampel. Data dianalisis menggunakan SPSS 21

Hasil: Jenis kelamin responden yang terlibat pada penelitian ini adalah laki-laki (50,8%) dan perempuan (49,2%) dimana memiliki persentase yang hampir sama. Hampir setengah responden penelitian berusia 41-60 tahun (47,7%). Sekitar 92,3%, pasien merupakan dispepsia organik dan 7,7%, merupakan dispepsia fungsional. Sedangkan diagnosis terbanyak pada hasil pemeriksaan endoskopi adalah gastritis (40,0%) dan ditemukan pada kelompok usia muda (≤ 64 tahun).

Kesimpulan: Pasien dengan gejala dispepsia sebagian besar berjenis kelamin laki-laki, berusia dewasa muda, memiliki dispepsia organik, dan gambaran pemeriksaan endoskopi didominasi oleh gastritis pada usia muda.

Tingkat pengetahuan dan sikap tentang hepatitis B pada dokter gigi di Denpasar Utara

Introduction: Hepatitis B virus is a double stranded DNA virus that belongs to hepadnaviridae family. This virus can be transmitted through unsterile medical instruments, unsafe sex, and blood transfusions from hepatitis B infected individuals. This study aims to evaluate the knowledge and attitude of hepatitis B among dentist in North Denpasar.

Method: This study was a descriptive cross sectional study. Data collection was done by using questionnaire. The study population were dentists in North Denpasar. Subject consisted of 28 respondents that were chosen by random sampling. Study was done from November 2016 until January 2017.

Result: Majority of the respondent had a high knowledge level (75%) regarding transmission of hepatitis B. Similar proportion was found for high and low knowledge level regarding prevention of hepatitis B. Most respondent (57.8%) had a low level of knowledge regarding hepatitis B in general. More respondent had a positive attitude regarding hepatitis B (71.4%). Majority of respondent aged <30 years old had a good knowledge (64.2%), meanwhile bad knowledge was found in more respondent for other age group. Based on the characteristic of attitude regarding hepatitis B according to age and gender, it was found that more respondent had a positive attitude in each group.

Conclusion: Results of this study found that most of the respondent had a good knowledge and attitude regarding hepatitis B, but the knowledge in respondent aged over 30 were found to be bad.

Pendahuluan: Virus hepatitis B merupakan virus DNA beruntai ganda yang termasuk dalam famili hepadnaviridae. Penularan hepatitis B terjadi melalui alat medis tidak steril, hubungan seksual berisiko, dan transfusi darah dari individu yang terinfeksi virus hepatitis B. Penelitian ini dilakukan untuk mengetahui tingkat pengetahuan dan sikap mengenai hepatitis B pada dokter gigi di Denpasar Utara.

Metode: Penelitian ini merupakan studi deskriptif cross-sectional dengan metode pengumpulan data melalui kuisioner. Subjek penelitian adalah dokter gigi di Denpasar Utara. Sejumlah 28 sampel dipilih dengan teknik random sampling yang dilaksanakan dari November 2016 hingga Januari 2017.

Hasil: Mayoritas subjek memiliki tingkat pengetahuan yang tinggi (75%) mengenai penyebaran hepatitis B.  Proporsi yang sama didapatkan untuk tingkat pengetahuan tinggi dan rendah mengenai pencegahan hepatitis B. Mayoritas subjek (57,8%) memiliki tingkat pengetahuan yang rendah tentang hepatitis B secara umum. Lebih banyak responden didapatkan memiliki sikap positif terhadap hepatitis B (71,4%). Sebagian besar responden berusia <30 tahun memiliki tingkat pengetahuan yang baik (64,2%), sedangkan tingkat pengetahuan buruk lebih banyak didapatkan pada kedua kelompok usia lainnya. Berdasarkan karakteristik sikap dokter gigi terhadap hepatitis sesuai umur maupun sesuai jenis kelamin, pada tiap kelompoknya didapatkan lebih banyak responden yang memiliki sikap positif.

Simpulan: Hasil penelitian menunjukkan bahwa tingkat pengetahuan dan sikap tentang hepatitis B pada dokter gigi di Denpasar Utara sebagian besar adalah baik, namun pada kelompok usia diatas 30 tahun, tingkat pengetahuan terkait hepatitis B adalah kurang baik.

Faktor – faktor yang berhubungan dengan kejadian anemia pada anak usia 6-59 bulan di RSUD Wangaya, Denpasar, Bali, Indonesia tahun 2019

Background: Anemia is one of the four micronutrient problems in Indonesia. Based on Global Prevalence on Anemia, the Southeast Asian region is one of the areas with the highest prevalence of anemic populations, more than 53.8% of children aged 6-59 months were classified as mild anemia, and 3.6% of them are severe anemia. In the first 1000 day birth gold period, anemia was associated with delays and developmental disorders, both motor and intellectual, which may be irreversible. This study aims to analyze the risk factors for the incidence of anemia to optimize child development.

Objective: To analyze the relations of the risk of age under two years old, low birth weight, underweight, short stunting, and not exclusive breastfeeding, to the incidence of anemia in children aged 6-59 months in Kaswari Room, Wangaya General Hospital, Denpasar in 2019.

Methods: Observational analytic epidemiology design with case-control study. The research subjects were determined by consecutive sampling method and fulfilled the inclusion criteria with a comparison of case and control groups, namely 1: 1. Data were analyzed bivariate by chi-square statistical test and Odds Ratio (OR) at the significance limit of α=5%, and multivariate analysis was performed with logistic regression test. Data was processed using the Statistical Package for Social Science (SPSS) version 23 for Windows program.

Results: The research subjects were 62 samples, consisting of 31 anemia samples, and 31 samples had no anemia. The results showed that there was no significant relationship between the risk of low birth weight and the incidence of anemia (95% CI = 0.80 - 22.29; p: 0.073), the risk of malnutrition with the incidence of anemia (95% CI = 0.81 - 63.85; p: 0.052), and the risk of not exclusive breastfeeding with the incidence of anemia (95% CI = 0.21 - 1.63; p: 0.440). However, there was a significant relationship between the risk of age <2 years with the incidence of anemia (OR 3.870; 95% CI = 1.34 - 11.17; p: 0.022) and the risk of short stature with the incidence of anemia (OR 7.686; 95% CI = 1, 92 - 30.70; p: 0.002). Logistic regression test results obtained significant results in short stature variables (sig 0.020; OR 5.379).

Conclusion: age <2 years and short stature (stunting) have a significant relationship with the incidence of anemia in children aged 6-59 months in Kaswari Room, Wangaya Hospital, Denpasar in 2019.

Latar belakang : Anemia merupakan salah satu dari empat masalah gizi mikro masyarakat Indonesia. Berdasarkan Global Prevalence on Anaemia, regio Asia Tenggara menjadi salah satu kawasan dengan prevalensi tertinggi populasi anemia, lebih dari 53,8% anak usia 6-59 bulan diklasifikasikan anemia ringan, serta 3,6% di antaranya adalah anemia berat¹. Pada periode emas 1000 HPK, anemia berhubungan dengan keterlambatan dan gangguan perkembangan baik motorik maupun intelektual yang mungkin irreversible². Penelitian ini bertujuan untuk menganalisis faktor-faktor risiko kejadian anemia sebagai langkah mengoptimalkan tumbuh kembang anak.

Tujuan : Menganalisis hubungan risiko usia  < 2 tahun, berat badan lahir rendah, gizi kurang (underweight), perawakan pendek (stunting), dan tidak ASI eksklusif, terhadap kejadian anemia pada anak usia 6-59 bulan di Ruang Kaswari, RSUD Wangaya, Denpasar tahun 2019.

Metode : Rancangan epidemiologi analitik observasional dengan desain studi case control. Subyek penelitian ditentukan dengan metode consecutive sampling, serta memenuhi kriteria inklusi dengan perbandingan kelompok kasus dan kontrol yaitu 1:1. Data dianalisis bivariat dengan  uji statistic chi-square dan Odds Ratio (OR) pada batas kemaknaan α 5%, serta dilakukan analisis multivariat dengan uji regresi logistic. Data diproses menggunakan program Statistical Package for Social Science (SPSS) versi 23 for Windows.

Hasil : Subjek penelitian sejumlah 62 sampel, terdiri dari 31 sampel anemia dan 31 sampel tidak anemia. Hasil penelitian menunjukkan bahwa tidak didapatkan hubungan bermakna antara risiko berat badan lahir rendah dengan kejadian anemia (95% CI = 0,80 – 22,29; p:0,073), risiko gizi kurang dengan kejadian anemia (95% CI = 0,81 – 63,85; p:0,052),  serta risiko tidak ASI eksklusif dengan kejadian anemia (95% CI = 0,21 – 1,63; p:0,440). Namun didapatkan hubungan bermakna antara risiko usia < 2 tahun dengan kejadian anemia (OR 3,870; 95% CI = 1,34 – 11,17; p:0,022) dan risiko perawakan pendek dengan kejadian anemia (OR 7,686; 95% CI = 1,92 – 30,70; p:0,002). Hasil uji regresi logistic, didapatkan hasil bermakna pada variabel perawakan pendek (sig 0,020; OR 5,379).

Kesimpulan:  usia < 2 tahun dan perawakan pendek (stunting) memiliki hubungan bermakna dengan kejadian anemia pada anak usia 6-59 bulan di Ruang Kaswari, RSUD Wangaya, Denpasar tahun 2019.

Efek pemberian ekstrak etanol bawang putih (Allium sativum) sebagai hepatoprotektor pada tikus putih jantan galur wistar (Rattus norvegicus) yang diinduksi parasetamol dosis hepatotoksik

Garlic (Allium sativum) is a plant that known to have various properties that can be used in treatment as a hepatoprotective agent. This study aim was to determine the effect of garlic ethanol extract (Allium sativum) in Wistar strain white male rats (Rattus norvegicus) which was induced by paracetamol in hepatotoxic dose. This research is an experimental study with randomized the post-test only control group design with sample consisted of twenty-four Wistar strain white male rats (Rattus norvegicus). The sample were divided into four groups: control groups, group P1 (given garlic ethanol extract 10 mg/kg), group P2 (ethanol extract of garlic was given 20 mg/kg) and group P3 (given the ethanol extract garlic 30 mg/kg). This study for seventeen days. The entire samples were terminated in order to draw blood to examine SGPT and SGOT. The data of SGPT and SGOT examined by One Way ANOVA. Result showed that there was significant difference in SGPT and SGOT values between groups after given ethanol extract of garlic (Allium sativum) (α <0.05). From the analysis we can concluded that garlic ethanol extract (Allium sativum) can be used as a hepatoprotective agent in Wistar strain white male rats (Rattus norvegicus)  induced by paracetamol in hepatotoxic dose.

Gambaran prediktor perforasi pada penderita apendisitis di Rumah Sakit Umum Ari Canti Gianyar, Bali, Indonesia tahun 2018

Background: Acute appendicitis is one of the most common acute abdomen disease. Morbidity and mortality increased when the complications occur. The most severe complication is perforation which can cause peritonitis and sepsis. So it needs to be known as early as possible to prevent deterioration. This study aims to determine the predictor factors of perforation in appendicitis.

Method: This study was retrospective cross sectional design using secondary data from medical records of appendicitis patients treated at Aricanti Hospital, Gianyar in 2018. Total samples are 96 and they were selected by consecutive technique sampling. Data about age, sex, Total Leukocyte Count (TLC), and symptoms duration of appendicitis patients were collected and analyzed using the Chi-square test.

Result: From 96 samples, 33 (34.4%) were perforated appendicitis and 63 (65.6%) were acute appendicitis. Chi-square test results showed that the predictor factors associated with perforated appendicitis were age under 10 and above 49 years (PR = 2.0; X² = 5.474; p <0.05), male more affected than females (X² = 8.800; p < 0.05), TLC more than 18000/mm³ (PR = 3.3; X² = 20.862; p <0.05) and symptoms duration above 24 hours (PR = 4.1; X² = 24.834; p<0.05 ).

Conclusion: Age, sex, TLC, and symptoms duration can be used as predictors for perforated appendicitis. These predictor factors should be evaluated in appendicitis patients to prevent the occurrence of perforation or to provide immediate treatment in cases of perforation.

Latar Belakang: Apendisitis akut merupakan salah satu akut abdomen yang paling sering dijumpai. Peningkatan morbiditas dan mortalitas terjadi bila terjadi komplikasi. Komplikasi yang terberat adalah perforasi apendiks yang dapat menyebabkan peritonitis dan sepsis. Sehingga perlu diketahui sedini mungkin untuk mencegah perburukan. Penelitian ini bertujuan untuk mengetahui faktor prediktor perforasi pada kasus apendisitis.

Metode: Penelitian ini berdesain retrospektif cross sectional dengan menggunakan data sekunder berupa rekam medis pasien apendisitis yang dirawat di RSU Aricanti Gianyar tahun 2018. Sampel pada penelitian ini berjumlah 96 yang dipilih secara consecutive sampling. Data mengenai usia, jenis kelamin, Total Leukosit Count (TLC), dan symptoms duration pasien apendisitis dikumpulkan dan dianalisa menggunakan uji Chi-square.

Hasil: Dari 96 sampel, sebanyak 33 (34,4%) merupakan apendisitis perforasi dan 63 (65,6%) merupakan apendisitis akut. Hasil uji Chi-square menunjukan faktor prediktor yang berhubungan dengan apendisitis perforasi adalah usia dibawah 10 dan diatas 49 tahun (PR=2,0; X²= 5,474; p<0,05), jenis kelamin laki laki (X²=8,800; p<0,05), TLC lebih dari 18000/mm³ (PR=3,3; X²=20,862; p<0,05) dan symptoms duration diatas 24 jam (PR=4,1; X²=24,834; p<0,05).

Simpulan: Berdasarkan hasil uji statistik tersebut dapat disimpulkan bahwa usia, jenis kelamin, TLC, dan symptoms duration dapat dijadikan faktor prediktor terjadinya apendisitis perforasi. Faktor prediktor ini sebaiknya diperhatikan untuk mencegah kejadian perforasi pada pasien apendisitis ataupun memberikan penanganan yang lebih cepat pada kasus perforasi.

Efficacy of topical steroid therapy for phimosis treatment: a systematic review

Background: Circumcision is the gold standard in the management of phimosis cases. Nowadays, there is some basic science research that showed topical steroid might be used to decrease the morbidity of phimosis cases. This research aims to determine which management is more effective in treating phimosis by using a systematic evidence-based medicine approach.

Methods: Literature searching was done to find journals that are deemed appropriate for these cases. We included 3 RCT studies in this review. Critical appraisal was conducted to determine the efficacy of topical steroid. We compared those two methods in managing cases of phimosis among children.

Results: Topical steroids effectively cause the preputium skin be soft and comfortable to retract. In several cases, some patients had difficulty to get retracted. For these cases, circumcision is needed.

Conclusion: Topical steroid is effective in reducing the phimosis signs and symptoms, especially in patients who are younger and less than 3 years old. Further study and meta-analysis should be conducted in Indonesia to determine the effectiveness of this therapy in Indonesia.

Perbedaan nilai Neutrophil Lymphocyte Ratio (NLR) terhadap pemeriksaan kultur darah dalam mendiagnosis sepsis pada pasien peritonitis di RSUP Sanglah, Bali, Indonesia

Background: Sepsis is a leading cause of death worldwide. A delayed or missed diagnosis of sepsis could increase its morbidity and mortality. The abdomen is the most common source of sepsis, which known as peritonitis-induced-sepsis. Peritonitis leads to an inflammatory and anti-inflammatory response. This study aims to elaborate on the role of Neutrophil Lymphocyte Ratio (NLR) as an easy, fast and inexpensive infection marker compared to blood culture, which known as the gold standard of sepsis in peritonitis patients. 

Methods: This is a diagnostic study which combined secondary data taken at Sanglah Hospital Medical Record Department and new cases of generalized peritonitis patients with sepsis who came to Surgical Emergency Unit of Sanglah Hospital as the subjects. A total of 86 subjects, complete blood count analysis was done to calculate NLR. Besides, 2-sided blood culture was tested to see whether the results were positive or negative. Data were analyzed using Stata/SE version 12.1

Results: We found that sensitivity of NLR compared to blood culture was 80% (CI:63.1-91.6), with specificity of 88.2% (CI:76.1-95.6), positive predictive value of 82.4% (CI:65.5-93.2), negative predictive value of 86.5% (74.2-94.4), accuracy of 84.9% and likelihood ratio (LR) positive value of 6.8>1. Our results showed that NLR has an enormous value in predicting the occurrence of sepsis in patients with generalized peritonitis. 

Conclusion: NLR can be used as a screening tool for sepsis in generalized peritonitis patients because it has better sensitivity and accuracy, but it has to confirmed by blood culture as the gold standard.

Latar belakang: Sepsis merupakan penyebab kematian diseluruh dunia. Keterlambatan atau kesalahan dalam mendiagnosis dapat menyebabkan peningkatkan morbiditas dan mortalitas. Abdomen merupakan sumber penyebab paling sering terjadinya sepsis yang disebut dengan sepsis diinduksi peritonitis (peritonitis-induced sepsis). Penelitian ini bertujuan untuk menguji kemampuan Neutrophil Lymphocyte Ratio (NLR) sebagai marker infeksi yang mudah, cepat dan murah dibandingkan kultur darah yang merupakan standar baku dalam mendiagnosis sepsis pada pasien peritonitis.

Metode: Rancangan penelitan yang digunakan dalam penelitian ini adalah uji diagnostik dengan subjek penelitian  merupakan gabungan antara data sekunder yang diambil di Instalasi Rekam Medis RSUP Sanglah serta identifikasi kasus baru yaitu pasien sepsis pada peritonitis generalisata yang datang ke IRD Bedah RSUP Sanglah sehingga jumlah total sampel 86 orang. Pasien kemudian diambil darah lengkap untuk nilai NLR dan kultur darah 2 sisi apakah hasilnya positif atau negatif. Data dianalisis menggunakan Stata/SE versi 12.1

Hasil:   Dari penelitian ini didapatkan sensitifitas NLR dibandingkan dengan kultur darah adalah sebesar 80% (CI: 63,1-91,6) dengan spesifitas 88,2% (CI: 76,1-95,6), nilai prediktif positif 82,4% (CI: 65,5-93,2), nilai prediktif negatif 86,5% (CI: 74,2-94,4) dan akurasi 84,9%, serta nilai likelihood ratio (LR) positif didapatkan 6,8>1. NLR mempunyai nilai yang besar dalam meprediksi terjadinya sepsis pada pasien peritonitis generalisata.

Simpulan: NLR dapat digunakan sebagai skrinning pasien sepsis pada peritonitis generalisata karena memiliki sensistifitas dan akurasi yang lebih baik tetapi tetap dikonfirmasi dengan kultur darah sebagai standar baku.

Analisis korelasi kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah, Bali, Indonesia

Background: Sepsis is a systemic inflammatory response to infection, where the pathogen or toxin is released into the blood circulation, causing activation of the inflammatory process. Laboratory tests are used to detect inflammatory processes, one of which is procalcitonin. This study aims to determine the correlation between procalcitonin (PCT) serum levels by the leukocytes counts on suspected sepsis patients at Sanglah Hospital in Denpasar.

Methods: An analytic observational study with the cross-sectional design was conducted among 21 samples by consecutive sampling technique. The population in this study were sepsis patients who were treated at Sanglah Hospital Denpasar during February-June 2016 period. Data were analyzed using SPSS version 17 for Windows. 

Results:  Most of respondents were >35 years old (85.7%), Body Mass Index (BMI) > 20 kg/m2 (76.2%), leucocyte counts < 10.000/μL (42.9%), and PCT levels ≤ 0.5 ng/mL (61.9%). There is no significant correlation between white blood cells (WBC) and PCT by Spearman Correlation test (p=0.061; r=0,641).

Conclusion: The recent findings suggest that there was no significant correlation between PCT serum levels with the leucocytes counts among patients with sepsis.

Latar Belakang: Sepsis merupakan suatu respon inflamasi sistemik terhadap infeksi, dimana patogen atau toksin dilepaskan ke dalam sirkulasi darah sehingga terjadi aktivasi proses inflamasi. Tes laboratorium yang digunakan untuk mengetahui adanya proses inflamasi salah satunya adalah prokalsitonin (PCT). Penelitian ini bertujuan untuk mengetahui korelasi antara kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah Denpasar.

Metode: Penelitian observasional analitik dengan desain tong lintang dilakukan terhadap 21 sampel dengan teknik konsekutif. Populasi dalam penelitian ini adalah pasien sepsis yang dirawat di Rumah Sakit Sanglah Denpasar selama periode Februari-Juni 2016. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Sebagian besar responden berusia> 35 tahun (85,7%), Indeks Massa Tubuh (IMT)>20 kg / m2 (76,2%), jumlah leukosit <10.000 / μL (42,9%), dan tingkat PCT ≤ 0,5 ng / mL (61,9%). Tidak terdapat korelasi yang bermakna antara sel darah putih (WBC) dan PCT dengan uji Korelasi Spearman (p = 0,061; r = 0,641).

Kesimpulan: Hasil penelitian saat ini menunjukkan bahwa tidak terdapat korelasi yang bermakna antara kadar serum PCT dengan jumlah leukosit pada pasien dengan sepsis.

Gambaran tingkat pengetahuan tentang Periksa Payudara Sendiri (SADARI) pada mahasiswa Fakultas Kedokteran Universitas Udayana, Bali, Indonesia angkatan 2013-2015

Background: BSE (Breast Self-Examination) is a systematic approach to inspection and palpation examination of the chest and armpit independently. BSE can be used as a means of early detection of breast cancer using a simple, inexpensive and safe. This study aims to determine the level of knowledge about BSE among students of Medical Education Faculty of Medicine Udayana University class of 2013, 2014 and 2015.

Methods: A descriptive cross-sectional study was conducted among 285 respondents at Faculty of Medicine, Medical Education Program class of 2013, 2014, and 2015. The instrument used in this study was a valid and reliable questionnaire to identify the respondents' knowledge about breast cancer and BSE. Questionnaire data that has been collected is processed in the form of descriptive data analysis by calculating proportion and percentages. Data were analyzed using SPSS version 17 for Windows.

Results: The highest average score about SADARI were obtained in Class 2013 (75%), followed by Class 2014 (72%), and Class 2015 (67%) students. A high level of knowledge criteria about SADARI also suggest similar results where Class 2013 was having the highest percentage (63%), followed by Class 2014 (25%), and Class 2015 (8%). However, based on the overall results, the students had a moderate score of 66%. Besides, according to the questions on the questionnaire, the students had an excellent average score about signs and symptoms (83%), cause (79%), and stage of breast cancer (79%).

Conclusion: Class 2013 had a good level of knowledge regarding SADARI compared with Class 2014 and 2015. However, overall students still at a moderate average score of SADARI.

Latar Belakang: SADARI (Periksa Payudara Sendiri) adalah metode sistematik untuk pemeriksaan inspeksi dan palpasi dada dan ketiak secara mandiri. SADARI dapat digunakan sebagai cara deteksi dini kanker payudara dengan menggunakan cara yang sederhana, murah dan aman. Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan mengenai SADARI Mahasiswa Pendidikan Dokter Fakultas Kedokteran Universitas Udayana angkatan 2013, 2014 dan 2015.

Metode: Sebuah studi potong lintang deskriptif dilakukan terhadap 285 responden di Fakultas Kedokteran, Program Pendidikan Kedokteran kelas 2013, 2014, dan 2015. Instrumen yang digunakan dalam penelitian ini adalah kuesioner yang sahih dan reliabel untuk mengidentifikasi pengetahuan responden tentang kanker payudara dan BSE. Data kuesioner yang telah dikumpulkan diolah dalam bentuk analisis data deskriptif dengan menghitung proporsi dan persentase. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Nilai rata-rata tertinggi tentang SADARI diperoleh pada siswa di Kelas 2013 (75%), diikuti oleh Kelas 2014 (72%), dan Kelas 2015 (67%). Kriteria tingkat pengetahuan tinggi tentang SADARI juga memberikan hasil yang serupa di mana Kelas 2013 memiliki persentase tertinggi (63%), diikuti oleh Kelas 2014 (25%), dan Kelas 2015 (8%). Namun, berdasarkan hasil keseluruhan, para siswa memiliki skor sedang 66%. Selain itu, menurut pertanyaan pada kuesioner, para siswa memiliki skor rata-rata yang sangat baik tentang tanda dan gejala (83%), penyebab (79%), dan stadium kanker payudara (79%).

Kesimpulan: Kelas 2013 memiliki tingkat pengetahuan yang baik tentang SADARI dibandingkan dengan Kelas 2014 dan 2015. Namun, keseluruhan siswa masih berada pada skor rata-rata SADARI yang moderat.

Perbedaan olahraga aerobik intensitas sedang dan High-Intensity Interval Training (HIIT) terhadap kebugaran fisik pada mahasiswa Fakultas Kedokteran Universitas Udayana, Bali, Indonesia

Background: Exercise is a healthy habit, which is already a lot of becoming obsolete. In addition to able to increase our endurance, it can also indirectly reduce or even cure some disease. This study aims to know the difference in physical fitness between aerobic exercise with moderate intensity and High-Intensity Interval Training (HIIT).

Methods: A randomized observational experimental study using pre- and post-test group design was conducted among 16 respondents at Department of Physiology, Faculty of Medicine, Universitas Udayana, Bali, Indonesia during March-April 2016. The respondents were divided into 2 groups: Group 1 for High-Intensity Interval Training (HIIT) and Group 2 for moderate aerobic intensity exercise. Harvard Step Test was carried out to determine the physical fitness between both groups. Data were analyzed using SPSS version 23 for Windows. 

Results: Most of the respondents were males (68.75%) and age 21 years-old (68.75%). Mann-Whitney test found no significant difference between HIIT and moderate training before and after the exercise (p=0.293; p=0.247). However, a significant difference in physical fitness by Wilcoxon Test before and after exercise was found in HIIT (p=0.001) and moderate exercise (p=0.001) groups.

Conclusion: By doing aerobic exercise training, either high or moderate-intensity, can lead to an increase in physical fitness. However, the difference obtained from both types of training is not too visible or insignificant.

Latar Belakang: Olahraga merupakan suatu kebiasaan sehat yang selama ini sudah banyak mulai ditinggalkan. Disamping mampu meningkatkan ketahanan tubuh kita, olahraga juga dapat secara tidak langsung mengurangi atau bahkan meyembuhkan beberapa penyakit. Penelitian ini bertujuan untuk mengetahui perbedaan antara olahraga aerobik dengan intensitas sedang dan High-Intensity Interval Training (HIIT).

Metode: Penelitian eksperimental observasional acak menggunakan rancangan kelompok sebelum dan sesudah pengujian dilakukan terhadap 16 responden di Departemen Fisiologi, Fakultas Kedokteran, Universitas Udayana, Bali, Indonesia selama Maret-April 2016. Para responden dibagi menjadi 2 kelompok: Grup 1 untuk Pelatihan Interval Intensitas Tinggi (HIIT) dan Grup 2 untuk pelatihan olahraga aerobic intensitas sedang. Harvard Step Test dilakukan untuk menentukan kebugaran fisik antara kedua kelompok. Data dianalisis menggunakan SPSS versi 23 untuk Windows.

Hasil: Sebagian besar responden adalah laki-laki (68,75%) dan berusia 21 tahun (68,75%). Uji Mann-Whitney tidak menemukan perbedaan yang bermakna antara HIIT dan pelatihan sedang sebelum dan sesudah latihan (p = 0,293; p = 0,247). Namun, perbedaan yang bermakna dalam kebugaran fisik oleh Tes Wilcoxon sebelum dan sesudah latihan ditemukan pada kelompok HIIT (p = 0,001) dan olahraga sedang (p = 0,001).

Kesimpulan: Dengan melakukan latihan aerobik, baik intensitas tinggi atau sedang, dapat menyebabkan peningkatan kebugaran fisik. Namun, perbedaan yang didapat dari kedua jenis pelatihan ini tidak terlalu terlihat atau tidak signifikan.

Gambaran perkembangan kognitif dan bahasa pada anak usia di bawah 3 tahun di Taman Pengasuhan Anak (TPA)/(Daycare) Kota Denpasar, Bali

Background: Speech and language developmental disorders can affect various functions in learning difficulties. This often happens to children who are less stimulated because today, many parents work so that child care will be reduced. Therefore, the childcare park (TPA) can be a choice of place to leave the child so that it is expected to get proper stimulation according to age level. This study aims to assess the status of cognitive and language development in children under 3 years of age at the Denpasar City, Bali.

Methods: A cross-sectional study was conducted to 48 children who were in 4 TPAs in Denpasar during February 2018. Variables assessed in this study included cognitive and language aspects using adaptive cognitive test (CAT) / clinical linguistic & auditory milestone scale questionnaires. (CLAMS) that is valid and reliable. The research data obtained were analyzed using SPSS software version 19 for Windows.

Results: Most respondents were female (56.3%), mean age 19.5 ± 10.0 months, and have high levels of education for both fathers (87.5%) and mothers (91.7%). The Caput Scale results show that the average DQ CAT value is 98.1 ± 11.0, DQ CLAMS 92.1 ± 12.0, and FSDQ 95.1 ± 11.0. As many as 27.1% of children in TPA have abnormal FSDQ score. The FSDQ score of the respondent's characteristics showed that most of the normal values were obtained for male (76.2%), high education on fathers (78.5%) and mothers (77.2), as well as jobs as a civil servant for fathers (73.3) and mothers (78.6)

Conclusion: About 27.1% of children experience cognitive and language impairment in TPA through CAT/CLAMS examination. In this regard, further assessment with a better research design is needed to find a causal effect.

Latar Belakang: Gangguan perkembangan bicara dan bahasa dapat memengaruhi berbagai fungsi dalam kesulitan belajar. Hal ini sering terjadi pada anak yang kurang mendapat stimulasi dikarenakan saat ini banyak orang tua bekerja sehingga pengasuhan terhadap anak akan berkurang. Oleh karena itu Taman pengasuhan anak (TPA) dapat menjadi pilihan tempat untuk menitipkan anak sehingga diharapkan mendapatkan stimulasi yang baik sesuai dengan tingkat usia. Penelitian ini bertujuan untuk menilai status perkembangan kognitif dan bahasa pada anak di bawah usia 3 tahun di TPA Kota Denpasar, Bali.

Metode: Penelitian ini menggunakan pendekatan potong lintang terhadap 48 anak yang berada pada 4 TPA di Denpasar pada bulan Februari 2018. Variabel yang dinilai pada penelitian ini meliputi aspek kognitif dan bahasa dimana menggunakan kuisioner cognitif adaptive test (CAT)/clinical linguistic & auditory milestone scale (CLAMS) yang sahih dan reliabel. Data penelitian yang diperoleh dianalisis menggunakan piranti lunak SPSS versi 19 untuk Windows.

Hasil: Sebagian besar responden berjenis kelamin perempuan (56,3%), usia rata-rata 19,5±10,0 bulan, dan tingkat pendidikan yang tinggi baik pada ayah (87,5%) maupun ibu (91,7%). Hasil Caput Scale menunjukkan bahwa rata-rata nilai DQ CAT adalah 98,1±11,0, DQ CLAMS 92,1±12,0, dan FSDQ 95,1±11,0. Sebanyak 27,1% anak di TPA memiliki nilai FSDQ tidak normal. Nilai FSDQ karakteristik responden menunjukkan sebagian besar nilai normal diperoleh pada laki-laki (76,2%), Pendidikan tinggi ayah (78,5%) dan ibu (77,2), maupun pekerjaan PNS pada ayah (73,3) dan ibu (78,6)

Simpulan: Anak yang mengalami gangguan fungsi kognitif dan bahasa di TPA sebanyak 27,1% melalui pemeriksaan CAT/CLAMS. Berkaitan dengan hal tersebut maka penilaian lebih lanjut dengan desain penelitian yang lebih baik diperlukan untuk mencari hubungan sebab akibat.

Sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia: laporan kasus

Background: Ectopic ureter is a condition when the ureter does not enter the bladder properly. The occurrence of the ectopic ureter is 1:2.000 - 1:4.000 in general population with gender ratio 6:1 in favour of females. More than 80% of cases of ectopic ureters are generally associated with complete duplication of the pelvic-ureteric system. Still, the ectopic ureter can also occur in a single pelvic-ureteric system, which is typically dysplastic or poorly functioning, such as in multicystic dysplastic kidney. This study aims to evaluate the current management of a single ectopic ureteral system with dysplastic multicystic kidneys at Sanglah General Hospital, Bali, Indonesia.

Case Description: A 3-year-old girl was referred to the urology clinic of Sanglah General Hospital with chief complaint cloudy urinary since 1,5 years ago. Past medical history, the patient had a recurrent urinary tract infection with fever. Physical examination and laboratory findings were normal. However, an abdominal ultrasound showed a multicystic dysplastic kidney. VCUG showed vesicoureteral reflux grade V and ectopic ureter. Cystoscopy with retrograde pyelography and ureterorenoscopy showed an ectopic ureter opening was located in the proximal urethra above the external sphincter. Nephroureterectomy was performed. After the surgical procedure, the patient was treated and had no complaint. The patient was discharged from the hospital four days after surgery.

 Conclusion: The management of ectopic ureteral cases varies for each case. In this regard, the nephroureterectomy surgery performed in the case has provided good outcomes.

Latar Belakang: Ureter ektopik merupakan suatu kondisi dimana ureter tidak masuk ke buli-buli pada tempat yang seharusnya. Insiden ureter ektopik 1:2.000 - 1:4.000 kelahiran pada populasi secara umum dengan perbandingan jenis kelamin perempuan lebih banyak daripada laki-laki, yaitu 6:1. Lebih dari 80% kasus ureter ektopik umumnya berhubungan dengan duplikasi sistem pelvis-ureter yang lengkap. Tetapi ureter ektopik juga dapat terjadi pada sistem pelvis-ureter tunggal, yang pada umumnya displastik atau fungsinya buruk, seperti pada keadaan ginjal multikistik displastik. Studi ini bertujuan untuk mengevaluasi manajemen terkini pada sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia.

Deskripsi Kasus: Seorang anak perempuan berusia 3 tahun dirujuk ke poliklinik urologi Rumah Sakit Sanglah dengan keluhan buang air kecil keruh sejak 1,5 tahun lalu. Riwayat penyakit dahulu, penderita mengalami infeksi saluran kemih berulang disertai demam. Hasil pemeriksaan fisik dan laboratorium normal. Hasil USG abdomen menunjukkan gambaran ginjal multikistik displastik, VCUG menunjukkan vesikoureteral refluks grade V dan ureter ektopik. Sistoskopi dengan retrograde pyelografi dan ureterorenoskopi menunjukkan muara ureter ektopik terletak di uretra proksimal di atas sfingter uretra eksterna. Lalu dilakukan tindakan nefroureterektomi. Setelah dioperasi, selama perawatan, pasien tidak memiliki keluhan. Pasien dipulangkan setelah empat hari perawatan.

Kesimpulan: Tatalaksana pada kasus ureter ektopik bervariasi untuk setiap kasus. Berkaitan dengan hal tersebut maka tindakan pembedahan nefrouretektomi yang dilakukan pada kasus tersebut telah memberikan luaran yang baik.

Procalcitonin (PCT) levels in pulmonary tuberculosis patients with acid fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis which enters the droplet nuclei into the mouth or nasal passages to reach the pulmonary alveoli. The sputum smear examination for smear-positive and negative smear pulmonary tuberculosis is challenging due to requiring a longer time to get the results. Therefore, a specific marker is needed that is able to detect bacterial infections immediately, such as procalcitonin (PCT). This study aims to determine the levels of PCT in pulmonary tuberculosis patients with acid-fast bacilli positive and negative smear at Haji Adam Malik General Hospital, Medan, Indonesia.

Method: A cross sectional was conducted among 40 pulmonary tuberculosis patients who met the inclusion and exclusion criteria at Haji Adam Malik General Hospital, Medan, Indonesia. The subjects were 20 positive smears and 20 negative smears. PCT examination with mini VIDAS BRAHMS was carried out using the Sandwich principle using the ELFA method (Enzyme-Linked Fluorescent Assay). Sputum examination was carried out by smear of Zhiel Neelsen smear, which was analyzed by the Mann-Whitney (Non-Parametric) test using SPSS version 17 for Windows. 

Results: Most of the respondents were males in both positive and negative smears group (65.0% and 70.0%, respectively) and not significantly different (P>0.05). The age of subjects was slightly older in positive smear (49.75 ± 17.993 years) compare with negative smear group (42.50 ± 14.816 years) but not statistically significant (P=0.172). The PCT levels in pulmonary tuberculosis patients with positive smear (0.1550; 21.65 ng/mL) differ significantly from the PCT levels in pulmonary tuberculosis patients with negative smear (0.05; 3.14 ng/mL) (p=0.0001). The cut off value using ROC found 0.06 ng/mL (AUC: 0.842) with a sensitivity of 80% and a specificity of 80%.

Conclusion: There was a significant difference in the level of procalcitonin in patients with pulmonary tuberculosis who smear-positive and smear-negative.

Prevalence of anemia on chronic kidney disease and its influenced factors in Sanglah General Hospital 2015-2017, Bali

Background: Anemia is the most common disease among chronic kidney disease (CKD) patients. Its prevalence increased gradually as kidney function decreased. Globally, it affects 1.62 billion people, which corresponds to 24.8% of the population.

Aim: To determine the prevalence of anemia on CKD and its influenced factors at Sanglah Hospital, Bali.

Method: This was a descriptive design study conducted in Sanglah General Hospital, Denpasar, Bali from 2015 until 2017. Medical records of the patients became the secondary data for this research.

Result: From 2015 to 2017, there were 384 cases of CKD and 95 were anemic in the hospital. The prevalence of this case was 24.7 %. The age group of 51 - 60 years had the highest case. The males majorly dominated anemia on CKD. Anemia in stage V of CKD patients was the highest, and it increased more significant as the stages worsen, and diabetes was the leading underlying disease among anemia in CKD patients followed by CVD and glomerulonephritis. The hemoglobin level mean and glomerular filtration rate was lower than the normal one.

Clinicopathological patterns of cervical carcinoma in pathological anatomy laboratory at RSUP Sanglah Denpasar, Bali since 2012-2016

Background: Carcinoma of the cervix is the second most common cancer in women worldwide, Cervical cancer is the most common cancer in women in developing countries. Cervical cancer is the fourth most common cancer in women overall, with an estimated 528,000 new cases in 2012. According to the data clinicopathology of cervical cancer in Bali its still in a small amount.

Aims: To obtain information about clinicopathology of cervical carcinoma from the year 2012 – 2016.

Methods: A descriptive design study is conducted to determine the clinical pathology profile of cervical carcinoma among patients in Sanglah Hospital, Denpasar, Bali in the year 2012 – 2016. Medical records of the patients were used as the secondary data for this research. This research used the histopathologic document that available in Pathological Anatomy at RSUP Sanglah which mainly reports about patient condition starting from the early anamnesis period until the exact diagnosis of the patient which is due to the laboratory examination or other.

Result and Conclusion: As of 2012 to 2016, there were 142 cases of cervical cancer patients in RSUP Sanglah.The age group of 41-50 years has the highest number of patients in the year 2012 – 2016 which is about 52 patients. Abnormal vaginal bleeding is the most common clinical finding of cervical cancer patients from the year 2012- 2016 and carries 53% in 142 cases. It is found out that the most common histopathologic type of cervical cancer from the year 2012 – 2016 is squamous cell followed by adenocarcinoma in the list.

Level of awareness of alzheimer’s disease among elderly people in Denpasar, Bali

Background: Alzheimer’s disease (AD) is a chronic, irreversible, progressive, neurodegenerative that slowly impair memory and thinking skills especially in elderly people. This study aims to determine the level of awareness of AD among elderly people in Denpasar, Bali.

Methods: A descriptive cross-sectional study was conducted by using self–administered validated questionnaire to determine the level of awareness of Alzheimer’s disease among the elderly people in Denpasar, Bali. The level of awareness could be classified into high awareness (>80%), moderate awareness (50-79%) and low awareness (<50%)

Results: There were 50 subjects with 50 years old or above enrolled in this study. Most of the respondents had low awareness (82%) to the AD. About 38% of elderly people knew about AD and 58% of respondents said losing memory is a common thing in old age. Low education was said responsible increasing the risk of AD (30%). Only about 24% answered depression was prone to AD. In addition, about 34% said there was no cure for Alzheimer’s disease.

Korelasi volume prostat terhadap derajat lower urinary tract symptoms

Introduction: Benign prostatic hyperplasia is a health problem whose incidence ranks second highest in the field of urology. One of the cause is the more severe the complaint that arises is the heavier prostat volume which can cause the iritative and obstructive symptoms or better known as lower urinary tract symptoms(LUTS) which will be assessed based of international prostate symptoms score (IPSS). This study aims to determine prostate volume correlation with lower urinary tract symptoms severity in RSUD dr. Zainoel Abidin Banda Aceh. Knowledge of the volume of the prostate is important in management of patients with benign prostatic hyperplasia.

Method: This study uses the Cross Sectional design by selecting respondents in accidental sampling with a total of 31 patient. The data obtained were then analyzed by the Spearman test.

Result: The univariat data shows that 18 patient (58.1%)  are in Grade III (31-50 cc) and the most coming patient have LUTS scoring symptoms level on moderate (8-19) are 12 patient (38.7%) and severe symptoms (20-35) are 17 patient (54.8%). The results of prostate volume with lower urinary tract symptoms data analysis show that the p-value = 0.323 (p>0.05).

Conclusion: The results of this study indicate that the prostate volume doesn’t have correlation with lower urinary tract symptoms severity in patient with benign prostatic hyperplasia in RSUD dr. Zainoel Abidin Banda Aceh.

Latar Belakang: Benign prostatic hyperplasia (BPH) merupakan masalah kesehatan yang insidensinya menempati urutan kedua tertinggi di bidang urologi. Salah satu penyebab semakin beratnya keluhan yang muncul adalah semakin besarnya volume prostat dan dapat menyebabkan gejala klinis berupa gejala iritatif dan obstruktif atau lebih dikenal dengan lower urinary tract symptoms (LUTS) yang akan dinilai berdasarkan international prostate symptoms score (IPSS).

Metode: Penelitian ini bertujuan untuk mengetahui korelasi volume prostat dengan derajat lower urinary tract symptoms di RSUD dr. Zainoel Abidin Banda Aceh. Pengetahuan tentang volume prostat sangat penting dalam menangani pasien-pasien dengan benign prostatic hyperplasia. Studi ini menggunakan desain Cross Sectional dengan memilih responden secara accidental sampling dengan jumlah sebanyak 31 pasien.

Hasil: Data yang didapat kemudian dianalisis dengan uji Spearman. Hasil analisis data univariat menunjukkan bahwa 18 orang pasien (58,1%) memiliki volume prostat Grade III (31-50 cc) dan paling banyak pasien yang memiliki skor derajat LUTS sedang (8-19) yaitu sebanyak 12 pasien (38,7%) dan derajat LUTS berat (20-35) sebanyak 17 pasien (54,8%). Hasil analisis data volume prostat dengan derajat LUTS menunjukkan bahwa nilai p-value = 0,323 (p>0,05).

Simpulan: Hasil penelitian ini menunjukkan bahwa volume prostat tidak memiliki korelasi dengan derajat LUTS pasien BPH di RSUD dr. Zainoel Abidin Banda Aceh.

Profil onikomikosis pada pasien lanjut usia di Rumah Sakit Umum Pusat Sanglah, Bali, Indonesia: studi retrospektif

Background: Fungal infections are one of the most common dermatologic conditions affecting elderly population. Elderly population is susceptible to all of the superficial mycoses such as tinea pedis, candidiasis, and onychomycosis in geriatric populations compared to other age groups.

Objective:  To determine the profile of onychomycosis among elderly patients over a period of 1 years (January 2018–August 2019) at Dermatology and Venereology outpatient clinic, Sanglah General Hospital

Methods:  Retrospective study was performed at Department of Dermatology and Venereology, Sanglah General Hospital, Denpasar, Bali. The data collected from patient’s register data of outpatient clinic.

Result:  A total of 11 patients were diagnosed with onychomycosis, consist of 5 women and 6 men. From these, 4 (36,3%) was reported with chronic systemic diseases and 7 (63,6%) reported with no concomitant diseases. The most common clinical sign were onychodystrophy, hyperkeratotic subungual and dyschromia (6 patients, 54,54%). Potassium hydroxide examination reveal positive results in all patient. From 5 patients, on culture examination, Candida (2 patients, 40%), Trichophyton rubrum (2 patients, 40%), and Trychophyton mentagrophytes (1 patient, 20%) were found. For therapy, there were 7 patients got combination therapy (fluconazole 150 mg and ciclopirox lacquer 8%) and 4 patients with single therapy (ciclopirox lacquer 8%).

Conclusion: Onychomycosis is more common in the elderly or geriatric patients, this occurs because old age can change the body's immune function, including decreased immune response to fight infections against viruses, bacteria, and fungi.

Pendahuluan: Infeksi jamur adalah salah satu kondisi dermatologis paling umum yang mempengaruhi populasi lansia. Populasi lansia rentan terhadap semua mikosis superfisial seperti tinea pedis, kandidiasis, dan onikomikosis pada populasi geriatri dibandingkan dengan kelompok usia lainnya.

Tujuan:  Untuk menentukan profil onikomikosis pada pasien usia lanjut selama 1 tahun (Januari 2018 - Agustus 2019) di poliklinik rawat jalan Dermatologi dan Venereologi, Rumah Sakit Umum Pusat Sanglah.

Metode:  Studi retrospektif dilakukan di Departemen Dermatologi dan Venereologi, Rumah Sakit Umum Pusat Sanglah, Denpasar, Bali. Data dikumpulkan dari data pendaftaran pasien di klinik rawat jalan.

Hasil:  Sebanyak 11 pasien didiagnosis menderita onikomikosis, terdiri dari 5 wanita dan 6 pria. Dari hasil ini, sebanyak 4 orang (36,3%) dilaporkan dengan penyakit sistemik kronis dan 7 orang (63,6%) dilaporkan tanpa penyakit bersamaan. Tanda klinis yang paling umum adalah onikodistrofi, hiperkeratotik subungual dan dischromia (6 pasien, 54,54%). Pemeriksaan kalium hidroksida mengungkapkan hasil positif pada semua pasien. Dari 5 pasien pada hasil pemeriksaan kultur ditemukan adanya infeksi Candida (2 pasien, 40%), Trichophyton rubrum (2 pasien, 40%), dan Trychophyton mentagrophytes (1 pasien, 20%). Untuk penatalaksanaan, terdapat sejumlah 7 orang pasien mendapatkan terapi kombinasi (fluconazol 150 mg dan ciclopirox lacquer 8%) dan 4 orang pasien dengan terapi tunggal (ciclopirox lacquer 8%).

Simpulan: Onikomikosis lebih sering terjadi pada pasien usia lanjut atau usia lanjut dimana hal ini terjadi karena usia tua dapat mengubah fungsi kekebalan tubuh, termasuk penurunan respons imun untuk melawan infeksi terhadap virus, bakteri, dan jamur.

Relaksasi autogenik menurunkan keluhan gastritis pada orang dengan infeksi HIV-AIDS (ODHA) di RSUD Wangaya, Bali, Indonesia

Background: The current society is demanded many obligations and responsibilities in daily life. This situation can affect the mental stress that leads to stress in facing many problems of life. Psychological stress has an impact on system disturbances in the digestive organs such as gastritis. People with HIV/AIDS (ODHA) are often faced with this condition, so one of the efforts that can be done is to do autogenic relaxation. This study aims to determine the differences in gastritis complaints of ODHA people before and after autogenic relaxation. 

Methods: A quasi-experimental study with pre-test and post-test without a control group was conducted among 21 respondents at Countermeasures AIDS at Badung Regency from May-September 2017. Variables assessed in this study were gender, type of works, marital status, the origin of respondents, and the symptoms of respondents before and after autogenic relaxation intervention. Data were analyzed using SPSS version 17 for Windows.

Results: Most of ODHA patients were males (61.9%), followed by working as housewives (28.6%), marriage (81.0%), and living in North Kuta (28.6%). There was a significant difference in the average value of gastritis symptoms before (1.77) and after autogenic relaxation treatment (1.53) (p=0.002). 

Conclusion: Autogenic relaxation therapy can reduce the symptoms of gastritis among ODHA patients at Wangaya Hospital, Bali, Indonesia. 

Latar belakang: Masyarakat saat ini dituntut dengan banyak kewajiban dan tanggung jawab dalam kehidupan sehari-hari. Keadaan ini akan berdampak pada tekanan mental yang mengarah pada stres dalam menghadapi banyak masalah kehidupan. Tekanan mental akan berdampak pada organ pencernaan seperti gastritis. Penderita HIV/AIDS (ODHA) kerap dihadapkan pada kondisi ini sehingga salah satu upaya yang dapat dilakukan adalah melakukan relaksasi autogenik. Penelitian ini bertujuan untuk mengetahui perbedaan keluhan gastritis pada ODHA sebelum dan sesudah relaksasi autogenik.

Metode: Sebuah penelitian eksperimental-semu dengan pre-test dan post-test tanpa kelompok kontrol dilakukan terhadap 21 responden pada Penanggulangan AIDS di Kabupaten Badung dari Mei-September 2017. Variabel yang dinilai dalam penelitian ini adalah jenis kelamin, jenis pekerjaan, status perkawinan, asal responden, dan gejala responden sebelum dan sesudah intervensi relaksasi autogenik. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Sebagian besar pasien ODHA adalah laki-laki (61,9%), diikuti dengan bekerja sebagai ibu rumah tangga (28,6%), menikah (81,0%), dan tinggal di Kuta Utara (28,6%). Ada perbedaan yang bermakna dalam nilai rata-rata gejala gastritis sebelum (1,77) dan setelah perawatan relaksasi autogenik (1,53) (p = 0,002).

Kesimpulan: Terapi relaksasi autogenik dapat mengurangi gejala grastritis di antara pasien ODHA di Rumah Sakit Wangaya, Bali, Indonesia.

Peranan p53 dalam perkembangan dan prognosis osteosarkoma: tinjauan pustaka

Background: Osteosarcoma is the most common non hematopoietic primary malignant tumor in the bone. Several factors have been related through the development and prognosis of osteosarcoma. One of them is the mutation of p53 gene that encodes p53 protein. This literature review aims to evaluate the role p53 in the progressiveness and prognosis of osteosarcoma.

Methods: A review of relevant literature was performed to elaborate p53 involvement in osetosarcoma. A total of 22 qualified published literature from 2006 until 2017 were collected from several electronic database as well as manual search and included in this review.

Results: P53 has an important role in maintaining genome integrity through its ability to induce genes involved in senescence process, DNA repair and apoptosis. Loss of P53 induces progenitor cells to proliferate and experience differentiation disturbances thereby increasing the potential malignant transformation to osteosarcoma. Loss of p53 also increases osteosarcoma progression by increasing proliferation and providing a good microenvironment for tumor cells. P53 causes inhibition to other tumor suppressor proteins such as BMP-2 and CD137L. Loss of P53 has a role in providing a good microenvironment for osteosarcoma cells to invade surrounding tissue, metastasis and suppressed immune response through increased activity of SDF-1, HIF-1α, VEGF, and NO. High mutant p53 expression has a positive association with short-term survival but does not have a strong association to predict long-term survival.

Conclusion: A p53 gene has a pivotal role in the progressiveness and prognosis of osteosarcoma through increasing proliferation and providing a good microenvironment for tumor cells

Latar Belakang: Osteosarkoma merupakan tumor ganas primer non hematopoietik tersering pada tulang. Berbagai faktor telah dikaitkan dengan perkembangan dan prognosis pasien osteosarkoma, Salah satunya adalah mutasi gen p53 yang menyandi protein p53. Tinjauan pustaka ini bertujuan untuk mengevaluasi peran p53 dalam progresif dan prognosis osteosarkoma.

Metode: Tinjauan pustaka yang relevan dilakukan untuk menguraikan keterlibatan p53 dalam osetosarcoma. Sebanyak 22 literatur yang diterbitkan berkualitas dari 2006 hingga 2017 dikumpulkan dari beberapa basis data elektronik serta pencarian manual dan dimasukkan dalam ulasan ini.

Hasil: P53 mempunyai peranan yang sangat penting dalam menjaga integritas genom melalui kemampuannya untuk menginduksi gen-gen yang terlibat dalam proses penuaan sel, perbaikan DNA maupun apoptosis. Hilangnya p53 menginduksi sel-sel progenitor osteosarkoma untuk berproliferasi dan mengalami gangguan diferensiasi sehingga meningkatkan potensi transformasi keganasan menjadi osteosarkoma. Kehilangan p53 juga meningkatkan progresivitas osteosarkoma melalui peningkatan proliferasi dan penyediaan lingkungan mikro yang baik bagi sel tumor. P53 menyebabkan hambatan fungsi protein penekan tumor lainnya yaitu BMP-2 dan CD137L. Kehilangan p53 berperan dalam menyediakan lingkungan mikro yang baik untuk sel-sel osteosarkoma untuk menginvasi jaringan sekitar, bermetastasis dan menghambat aktivitas sistem imun melalui peningkatan aktivitas SDF-1, HIF-1α, VEGF, dan NO. Ekspresi p53 mutan yang tinggi memiliki hubungan positif dengan angka harapan hidup jangka pendek namun tidak memiliki hubungan yang kuat untuk memprediksi harapan hidup jangka panjang.

Kesimpulan: Gen p53 memiliki peran penting dalam progresivitas dan prognosis osteosarkoma melalui peningkatan proliferasi dan menyediakan lingkungan mikro yang baik untuk sel tumor.

Durasi penggunaan lensa kontak dengan resiko terjadinya keratitis: tinjauan pustaka

Introduction: An increase in the incidence of refractive disorders provides an increasing need for visual aids such as glasses and contact lenses. The use of long-term contact lenses provides a new problem which is adana keratitis which can arise with prolonged use of contact lenses.

Objective: The literature review this time aims to provide a review of how long the role of contact lens use is at risk for keratitis.

Conclusion: Extended use of contact lenses can increase the risk for corneal keratitis. The choice of contact lens type characteristics and duration of use is a matter that should be observed to avoid the risk of keratitis.

Pendahuluan: Peningkatan kejadian kelainan refraksi memberikan semakin tingginya kebutuhan akan alat penunjang pengelihatan seperti kaca mata dan lensa kontak. Adanya penggunaan lensa kontak jangka panjang memberikan suatu masalah baru yang yaitu adana keratitis yang dapat muncul dengan lama penggunaan lensa kontak.

Tujuan: Tinjauan pustaka kali ini bertujuan untuk memberikan suatu ulasan mengenai bagaimana peranan penggunaan lensa kontak yang panjang terhadap risiko dari keratitis.

Simpulan: Penggunaan lensa kontak secara extended dapat meningkatkan risiko untuk terjadi keratitis kornea. Pemilihan karakteristik jenis lensa kontak dan durasi penggunaan menjadi hal yang patut dicermati untuk menghindari risko keratitis.

Periodontitis as early detection of diabetes mellitus: a literature review

Background: Diabetes mellitus (DM) is a growing health problem and its prevalence is dramatically increasing, particularly in Indonesia. It can affect every organ in the body, and one of the oral manifestations is periodontitis characterized by the loss of tissue attachment. This review aims to identify further the periodontitis as early detection of diabetes mellitus

Methods: A review of relevant literature was performed to elaborate on periodontitis involvement in diabetes mellitus. A total of 25 qualified published literature of all years were collected from several electronic database and manual search and included in this review.

Results: On average, patients with periodontitis showed higher glycated haemoglobin (HbA1c) plasma levels compared with individuals without periodontitis. Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycemia in diabetes is associated with adverse periodontal outcomes. Here, we show that periodontitis is an early sign of diabetes mellitus and may, therefore, serve as a valuable risk indicator. A dentist who got patient with periodontitis is a suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis.

Conclusion: Literature from a different type of study concluded that periodontitis is one of the oral manifestations that could be used as early detection in diabetes mellitus

Encapsulated liposome toward anthocyanin in Pectin-Based Dry Jelly as a management in pediatric obesity Management: a literature review

Background: In the globalization era, the high number of obesities is happened to the teenagers because of the unhealthy life-style. Obesity in the teenagers or pediatric obesity is important to be handled because it can trigger another complication that happened in the early age. This study aims to collect and analyze any source related to anthocyanin (ASN) from purple sweet potato (Ipomoea batatas L) as modality of obesity that is packaged as dry jelly.

Methods: A literature search strategy was conducted to obtained eligible source of study such as books and journals from Google Scholar, Research Gate, and PubMed. The criteria of eligible literature used in this study were articles published on 1981-2019 from different type of study. About 73 literature were used as references regarding the potency of ASN from purple sweet potato (Ipomoea batatas L) as the modality for obese people.

Results: ASN in the purple sweet potato has anti-obesity effect by decreasing the a-glucosidase enzyme and a-amylase, increasing glucagon-like-peptide-1 and peptide YY, changing the size of adipose cell, decreasing the lipogenic activity and inflammation, increasing the lipolysis and β-oxyanion adipose cell, as well as increasing the concentrate of brain-derived neutrophil factor in a brain. To increase the bioavailability of ASN, it has to be done the encapsulation with liposome base.  Modality is packaged in the dry jelly form with pectin base as a formulation in powder form taken orally. The modality consumption is 24 mg/kg of weight, however, after eating, the obese people tend to give the weight decreasing effect and cross section attractive to target modalities.

Conclusion: According to the studies, the ASN from purple sweet potato and package in Pectin-Based Dry Jelly could be used as a novel strategy in managing the pediatric obesity.

The physiological aspect of thyroid-induced breast cancer: a case report

Background: Breast cancer has the second-highest prevalence of cancer in Indonesia. The aetiology of breast cancer involves endogenous sex hormone activity, estrogen. Besides, thyroid hormones have estrogen-like effects on breast tissue which are thought to play a role in the development of breast cancer. This case report aims to evaluate the physiological aspect of thyroid-induced breast cancer.

Case Report: A 49-year-old Balinese woman came to the Primary Health Care with a history of uncontrolled hyperthyroidism for 5 years (2014-2019), complaining of a lump in her left breast. Open biopsy and immunohistochemistry were done (Grade III Invasive Carcinoma ER + 50%, Her + 2-3). Patients were diagnosed with stage 3B breast cancer and conservative treatment has been taken. The examination of TSH thyroid hormone was 0.204 µIU/mL (normal = 0.5 - 6 µIU/mL) and FT4 3.1 ng/dL (normal = 0.7-1.9 ng/dL).The primary management of patients was chemotherapy following by Modified Radical Mastectomy (MRM), hormone suppressant injection, as well as Herceptin. Those medications were effective in reducing the development of breast cancer through thyroid hormone pathway.

Testicular tunica vaginalis grafting for the treatment of Peyronie’s disease: a case report

Introduction: Peyronie’s disease (PD) is a progressive fibrotic tissue disorder of the penile tunica albuginea. PD can cause the formation of fibrous plaques, penile deformity, pain during erection, penile curvature, and erectile dysfunction (ED). Surgical treatment is the gold standard in PD because it is a fast and reliable therapy. There are many surgical options for PD such as plication procedures, incision and grafting procedures, and implantation of penile prosthesis. There are three types of graft material have been reported: autologous graft, xenograft and synthetic graft. Considering the higher rate of infections, inflammatory reactions and allergies, synthetic grafts are rarely used. Autologous graft is currently widely used because of the incidence of inflammatory reactions and low allergic reactions. Tunica vaginalis grafts are rarely used widely. Testicular tunica vaginalis was first reported as an autologous graft in 1980.

Case Report: A 53-year-old man comes to the urology clinic at Sidowaras Hospital complaining of pain during erection and erection cannot be straight. This complaint has been felt since a few months ago but the patient ignored it. An assessment of ED with International Index of Erectile Function (IIEF)-5 score obtained a score of 12 (mild-moderate dysfunction). Physical examination found a curvature of the penis around 70⁰ and in palpation there was a hard lump on the dorsal penis. After the diagnosis was made, testicular tunica vaginalis grafting procedure was performed on this patient. At a 6-month re-evaluation after surgery, patient-reported reduced penile pain on erection with improved erectile function score (IIEF)-5 score 21 (mild dysfunction).

Conclusion: Testicular tunica vaginalis grafting was chosen because it is feasible and safe for patient with PD. Testicular tunica vaginalis Grafting used due to their easy incorporation into host tissue and few incidences of local inflammatory reaction.

Jejunal atresia in the newborn: three cases after resection and end-to-end anastomoses

Background: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejunal atresia occurs more frequent than duodenal or colonic atresias while single atresias are most commonly encountered. Jejunal atresia is classified into 4 types: Type I (a mucosal/septal), Type II (a fibrous cord/band), Type III (blind ends are entirely separated without a fibrous cord between them and a large mesenteric defect), and Type IV (combination of atresia type I to III). This study aims to elaborate jejunal atresia in the newborn after resection and end-to-end anastomoses.

Case Description: We report three cases of jejunal atresia consists of different types: type IV (first case), type IIIa (second case) and type I (third case). Cases were neonates born with signs of upper gut obstruction. Bile-stained vomiting was reported a few hours after birth and failed to pass meconium in the first 24 hours. Postnatal abdominal X-ray showed dilatation of the gaster and no gas present in the pelvic floor. In the third case, it showed a triple bubble sign on abdominal x-ray and a laparotomy revealed the type of jejuno-ileal atresia. Also, the resection on the atresias and end to end anastomosis were performed. Cases were admitted to neonatal intensive care unit with total parenteral nutrition. The first two cases died due to sepsis, while the third case survived.

Conclusion: Jejunal atresia is a rare disease among newborn. All of the patients have provided resection and end-to-end anastomoses, although 2 of them did not survive. 

Revascularization limb salvage in chronic limb-threatening ischemia: does open surgery still the best option in the era of endovascular therapy?

Introduction: Chronic limb-threatening ischemia (CLTI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels who suffered from diabetes mellitus type 2, and also associated with physical, as well as psychosocial, consequences such as amputation and depression. Successful revascularization decreases the major amputation rate in patients with CLTI. The efficacy of peripheral bypass grafts and percutaneous transluminal angioplasty in accomplishing limb salvage has been recognized.

Case Description: A 42-year-old man came to the RSUZA emergency room with chief complaints claudication above the right thigh and continuous pain (rest pain) at the right lower extremity since 9 months ago. History of finger amputation 2^nd, 3^rd and 4^th right foot since 10 months ago at local hospital, and now there are necrotic wounds on his toes. Patients suffered from type 2 diabetes mellitus and have bad habits such as smoking 3 packs a day all the time. Physical examination has a wound in the lower leg area of more than 10 cm x 8 cm. Right ankle-brachial index (ABI) 0.6 and left ABI 1.3. CT-angiography (CTA) shows infra inguinal type D TASC II classification. A revascularization procedure is performed to salvage the limb with the right femoro-popliteal bypass technique with graft R-SVG and debridement in the right lower leg area so that chronic right lower limb ischemia can be overcome. Systemic heparinization was given post operatively and complaints of pain in the right lower limb begin to disappear. Patient was discharged on the 5^th day of treatment with good results.

Conclusion: Open surgical bypass continues to be a primary treatment of choice, durable approach in a significant proportion of patients. Lower extremity bypass grafting is most successful with a good quality, long, single-segment autogenous vein of at least 3.5mm diameter.